Abstract
Background
Surgery is the only option for curative treatment in patients with esophageal carcinoma. Despite the debates related to the peri-operative therapy regime, a generally accepted consensus on surgical approach is not reached yet. The debate focuses mainly on pros and cons between radical transthoracic resection and the (limited) transhiatal resection in the last decade.
Methods
The PubMed database was searched for randomized trials, meta-analyses, and retrospective single-center studies. The search terms were “esophageal carcinoma,” “esophageal junction carcinomas,” “transhiatal,” “transthoracic,” “morbidity,” “mortality,” and “surgery.”
Results
The radical transthoracic approach should be the standard of care for esophageal carcinoma since it does not go along with an increased risk of postoperative morbidity or mortality but reveals an improved survival. Patient-related co-morbidities are the most influencing factors for the postoperative outcome. For type II esophageal junction carcinoma, treatment options from transhiatal extended gastrectomy to esophagectomy with hemigastrectomy or esophagogastrectomy with colonic interposition are existing. In type III esophagogastric junction carcinomas, the transhiatal extended gastrectomy is the standard of care, and the minimally invasive approach should be performed in specialized centers.
Conclusion
Based on current available study results, this expert review provides a decision support for the best surgical strategy depending on tumor localization and patients’ characteristics.
Similar content being viewed by others
References
Lordick F, Holscher AH, Haustermans K, Wittekind C (2012) Multimodal treatment of esophageal cancer. Langenbecks Arch Surg. doi:10.1007/s00423-012-1001-1
Mariette C, Piessen G, Triboulet JP (2007) Therapeutic strategies in oesophageal carcinoma: role of surgery and other modalities. Lancet Oncol 8:545–553
Reeh M, Nentwich MF, von Loga K, Schade J, Uzunoglu FG, Koenig AM et al (2012) An attempt at validation of the seventh edition of the classification by the International Union Against Cancer for esophageal carcinoma. Ann Thorac Surg 93:890–896
Sobin LH, Gospodarowicz MK, Wittekind C (2010) International Union against Cancer. TNM classification of malignant tumours. 7th ed. Wiley, Chichester
Nishihira T, Hirayama K, Mori S (1998) A prospective randomized trial of extended cervical and superior mediastinal lymphadenectomy for carcinoma of the thoracic esophagus. Am J Surg 175:47–51
Yajima S, Oshima Y, Shimada H (2012) Neck dissection for thoracic esophageal squamous cell carcinoma. Int J Surg Oncol 2012:750456
Ott K, Lordick F, Molls M, Bartels H, Biemer E, Siewert JR (2009) Limited resection and free jejunal graft interposition for squamous cell carcinoma of the cervical oesophagus. Br J Surg 96:258–266
Klink CD, Binnebosel M, Otto J, Boehm G, von Trotha KT, Hilgers RD et al (2012) Intrathoracic versus cervical anastomosis after resection of esophageal cancer: a matched pair analysis of 72 patients in a single center study. World J Surg Oncol 10:159
Okuyama M, Motoyama S, Suzuki H, Saito R, Maruyama K, Ogawa J (2007) Hand-sewn cervical anastomosis versus stapled intrathoracic anastomosis after esophagectomy for middle or lower thoracic esophageal cancer: a prospective randomized controlled study. Surg Today 37:947–952
Nederlof N, Tilanus HW, Tran TC, Hop WC, Wijnhoven BP, de Jonge J (2011) End-to-end versus end-to-side esophagogastrostomy after esophageal cancer resection: a prospective randomized study. Ann Surg 254:226–233
Kim RH, Takabe K (2010) Methods of esophagogastric anastomoses following esophagectomy for cancer: a systematic review. J Surg Oncol 101:527–533
Bird P, Daniel F, MacLellan D (1996) Oesophagogastrectomy with an anastomosis using linear staplers. Aust N Z J Surg 66:757–763
Behrenbruch C, Kalogeropoulos G, Cade R (2012) The hybrid intrathoracic oesophago-gastric anastomosis in oesophageal cancer-morbidity and mortality: the hybrid intrathoracic oesophagogastric anastomosis. J Gastrointest Surg. doi:10.1007/s11605-012-2078-0
van Hagen P, Hulshof MC, van Lanschot JJ, Steyerberg EW, van Berge Henegouwen MI, Wijnhoven BP et al (2012) Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 366:2074–2084
Schroder W, Vallbohmer D, Bludau M, Banczyk A, Gutschow C, Holscher AH (2008) The resection of the azygos vein—necessary or redundant extension of transthoracic esophagectomy? J Gastrointest Surg 12:1163–1167
Bogoevski D, Bockhorn M, Koenig A, Reeh M, von Loga K, Sauter G et al (2011) How radical should surgery be for early esophageal cancer? World J Surg 35:1311–1320
Altorki NK, Zhou XK, Stiles B, Port JL, Paul S, Lee PC et al (2008) Total number of resected lymph nodes predicts survival in esophageal cancer. Ann Surg 248:221–226
Horstmann O, Verreet PR, Becker H, Ohmann C, Roher HD (1995) Transhiatal oesophagectomy compared with transthoracic resection and systematic lymphadenectomy for the treatment of oesophageal cancer. Eur J Surg 161:557–567
Peyre CG, Hagen JA, DeMeester SR, Altorki NK, Ancona E, Griffin SM et al (2008) The number of lymph nodes removed predicts survival in esophageal cancer: an international study on the impact of extent of surgical resection. Ann Surg 248:549–556
Yekebas EF, Schurr PG, Kaifi JT, Link BC, Kutup A, Mann O et al (2006) Effectiveness of radical en-bloc-esophagectomy compared to transhiatal esophagectomy in squamous cell cancer of the esophagus is influenced by nodal micrometastases. J Surg Oncol 93:541–549
Hulscher JB, van Sandick JW, de Boer AG, Wijnhoven BP, Tijssen JG, Fockens P et al (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347:1662–1669
Omloo JM, Lagarde SM, Hulscher JB, Reitsma JB, Fockens P, van Dekken H et al (2007) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid/distal esophagus: five-year survival of a randomized clinical trial. Ann Surg 246:992–1000, discussion 1000–1001
Kutup A, Link BC, Schurr PG, Strate T, Kaifi JT, Bubenheim M et al (2007) Quality control of endoscopic ultrasound in preoperative staging of esophageal cancer. Endoscopy 39:715–719
Merkow RP, Bilimoria KY, McCarter MD, Phillips JD, Decamp MM, Sherman KL et al (2012) Short-term outcomes after esophagectomy at 164 American College of Surgeons National Surgical Quality Improvement Program Hospitals: effect of operative approach and hospital-level variation. Arch Surg 147:1009–1016
Chandrasoma P, Makarewicz K, Wickramasinghe K, Ma Y, Demeester T (2006) A proposal for a new validated histological definition of the gastroesophageal junction. Hum Pathol 37:40–47
Chandrasoma P, Wickramasinghe K, Ma Y, DeMeester T (2007) Adenocarcinomas of the distal esophagus and "gastric cardia" are predominantly esophageal carcinomas. Am J Surg Pathol 31:569–575
Reeh M, Mina S, Bockhorn M, Kutup A, Nentwich MF, Marx A et al (2012) Staging and outcome depending on surgical treatment in adenocarcinomas of the oesophagogastric junction. Br J Surg 99:1406–1414
Schurr PG, Yekebas EF, Kaifi JT, Lasch S, Strate T, Kutup A et al (2006) Lymphatic spread and microinvolvement in adenocarcinoma of the esophago-gastric junction. J Surg Oncol 94:307–315
von Rahden BH, Stein HJ, Siewert JR (2006) Surgical management of esophagogastric junction tumors. World J Gastroenterol 12:6608–6613
Siewert JR, Feith M, Stein HJ (2005) Biologic and clinical variations of adenocarcinoma at the esophago-gastric junction: relevance of a topographic-anatomic subclassification. J Surg Oncol 90:139–146, discussion 146
Ellis FH Jr, Heatley GJ, Krasna MJ, Williamson WA, Balogh K (1997) Esophagogastrectomy for carcinoma of the esophagus and cardia: a comparison of findings and results after standard resection in three consecutive eight-year intervals with improved staging criteria. J Thorac Cardiovasc Surg 113:836–846, discussion 846–838
Hagen JA, Peters JH, DeMeester TR (1993) Superiority of extended en bloc esophagogastrectomy for carcinoma of the lower esophagus and cardia. J Thorac Cardiovasc Surg 106:850–858, discussion 858–859
Sasako M, Sano T, Yamamoto S, Sairenji M, Arai K, Kinoshita T et al (2006) Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia: a randomised controlled trial. Lancet Oncol 7:644–651
Luketich JD, Pennathur A, Awais O, Levy RM, Keeley S, Shende M et al (2012) Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg 256:95–103
Holscher AH, Fetzner UK (2012) Modern diagnostics and stage-oriented surgery: therapy of adenocarcinoma of the esophagogastric junction. Chirurg 83:702–708–710–711
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Uzunoglu, F.G., Reeh, M., Kutup, A. et al. Surgery of esophageal cancer. Langenbecks Arch Surg 398, 189–193 (2013). https://doi.org/10.1007/s00423-013-1052-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-013-1052-y